Abstract
BackgroundSeveral factors have been identified as being associated with increased adherence to antiretroviral therapy, including sero-status disclosure; however, studies examining the effect of disclosure on ART adherence in Ethiopia have had inconsistent findings. This systematic review and meta-analysis therefore aims to estimate the pooled effect of disclosure on adherence to ART among adults living with HIV in Ethiopia.MethodsWe performed a systematic search for articles reporting on peer-reviewed, quantitative, English-language observational studies of reporting the association between self sero-status disclosure and good ART adherence in adults living with HIV/AIDS in Ethiopia during published from 2010 to 2015. We searched four electronic databases: PubMed/Medline, the World Health Organization’s Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases) for studies from December 1, 2017 to January 30, 2018. We also searched university repositories and conference abstracts for unpublished studies. We conducted a meta-analysis for the pooled effect of adherence using a random effects model in Stata version 14 and assessed publication bias using the Egger’s test for funnel plot asymmetry.ResultsOur search returned in 179 studies, of which seven (3.9%), were eligible and included in the final meta-analysis. The seven included studies were conducted from 2010 to 2015. Our analysis found that disclosure had a significant effect on the adherence to ART in adult patients living with HIV. Patients who disclosed were 1.64 times more likely to have good adherence to ART compared with those who did not (OR: 1.64, 95% CI: 1.11, 2.42). The small number of studies eligible for review and differences in study definitions of adherence and disclosure were the main limitations of this study.ConclusionThis review found a statistically significant positive effect of disclosure status on the adherence to ART in adult patients living with HIV in Ethiopia. This suggests that Ethiopia’s national treatment and prevention programs should redouble efforts to encourage self-disclosure among people living with HIV/AIDS. Encouraging supportive social environments for disclosure, and promoting partner notification and partner disclosure support initiatives might be particularly helpful in this regard.
Highlights
Several factors have been identified as being associated with increased adherence to antiretroviral therapy, including sero-status disclosure; studies examining the effect of disclosure on ART adherence in Ethiopia have had inconsistent findings
This systemic review and meta-analysis attempted to estimate the pooled effect of disclosure on adherence to ART among adults living with Human immunodeficiency virus (HIV) in Ethiopia
Our results are in line with those from a systematic review of factors associated with adherence in sub-Saharan Africa, which found that disclosure among people living with HIV had a positive effect on ART adherence (OR = 3.46; 95% Confidence interval (CI) 2.04 to 5.89) [6]
Summary
Several factors have been identified as being associated with increased adherence to antiretroviral therapy, including sero-status disclosure; studies examining the effect of disclosure on ART adherence in Ethiopia have had inconsistent findings. This systematic review and meta-analysis aims to estimate the pooled effect of disclosure on adherence to ART among adults living with HIV in Ethiopia. The unprecedented global response to the HIV/AIDS pandemic of the 1990s brought millions of people living with HIV/AIDS (PLWHA) access to lifesaving antiretroviral therapy (ART). The success of these programs and the continuing challenges in developing and implementing effective HIV prevention interventions have meant that the number of people receiving ART has continued to grow steadily. In the region of the world most heavily affected by HIV/AIDS—eastern and southern Africa—UNAIDS estimates that 65% of PLWHA are receiving ART [2]; in Ethiopia, 75% of adult PLWHA (approximately 415,578 people) were receiving ART in 2017 [2]. Maintaining good patient adherence to ART in these programs continues to be challenging
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